neurocognitive disorders Flashcards
delirium
Disturbance in attention Abrupt onset with periods of lucidity Disorganized thinking Poor executive functioning Disorientation Anxiety and agitation Poor recall Delusions and hallucinations (usually visual)
- caused by medical
- resolves by treatment
application of the nursing process
Overall assessment
- Four cardinal features of delirium
1. Acute onset and fluctuating course
2. Reduced ability to direct, focus, shift, and sustain attention
3. Disorganized thinking
4. Disturbance of consciousness
what affected
Cognitive and perceptual disturbances
- Illusions: paperclip = big
- Hallucinations: visual- reaching out to something
Physical needs
Moods and physical behaviors: confusion, disoriented
Self assessment
delirium diagnosis
- Risk for injury: great risk for fall, clear room, 2 side rail
- Acute confusion: memory impaired, locx4, neuro assessment
- Risk for deficient fluid volume: assist w meals
- Disturbed sleep pattern: quiet, lights dim, morning more lucid
- Impaired verbal communication: may not make sense
- Fear
- Self-care deficits: adls help
I- mpaired social interaction: withdrawn, hypervilligent
delirium outcomes criteria
- Patient will remain safe and free from injury
- During periods of clarity, patient will be oriented to time, place, and person
- Patient will remain free from falls and injury while confused, with the aid of nursing safety measures
delirium planning
- Ensure necessary aids and supportive home team
- Visual cues in the environment for orientation
- Continuity of care providers
delerium implementation
- Prevent physical harm due to confusion, aggression, or fluid and electrolyte imbalance.
- Minimize use of restraints (increases confusion)
- Perform comprehensive nursing assessment to aid in identifying cause.
- Assist with proper health management to eradicate underlying cause.
- Use supportive measures to relieve distress.
what is Major and Minor Neurocognitive Disorders
- Progressive deterioration of cognitive functioning and global impairment of intellect (dementia)
- No change in consciousness
- Difficulty with memory, problem solving, and complex attention
- Mild: Does not interfere with ADLs; does not necessarily progress
- Major: Interferes with daily functioning and independence
major neuro
Alzheimer’s disease Frontotemporal dementia Dementia with Lewy bodies Vascular dementia Traumatic brain injury Substance-induced dementia HIV infection Prion disease Parkinson’s disease Huntington’s disease
clinical picture
- Alzheimer’s: 60% to 80% of all dementias
- Important to distinguish normal forgetfulness and memory deficits in dementia
- In dementia: memory loss interferes with ADLs
AD progression
- Mild
- Moderate
- Severe
Ad mild
forgot how to get home, usually remember eventually, feeling shame and denial
ad moderate
confusion increased, lost, wondering
ad severe
complete total care, can’t communicate
assessment of ad
Defense mechanisms
Denial (key)
Confabulation (creation of stories in place of missing memories to maintain self-esteem)
Perseveration (repetition of phrases or behavior)
Avoidance of questions
Self assessment
confabulation
creation of stories in place of missing memories to maintain self-esteem
preservation
repetition of phrases or behavior
symptoms of alzheimers
- Memory impairment
- Disturbances in executive functioning: concrete thinking
- Aphasia: Loss of language ability
- Apraxia: Loss of purposeful movement
- Agnosia: Loss of sensory ability to recognize objects
- agraphia: dimished ability eventual inability to read and write
- sundowning: tendency for mood to deteriorate and agitation to increase later in day and night
ad diagnosis test
Computed tomography scan (CT)
Positron emission tomography (PET)
Mental status questionnaires
ad exams
- Complete physical and neurological exam
- Complete medical and psychiatric history: CBC, vitamin b12, folate
- Review of recent symptoms, meds (polyfarm can cause confusion), and nutrition: dehydration
- CAM for delerium
self assessment for ad
- Realistic understanding of the disease
- Stress management
- Support and educational resources
- Realistic outcomes and recognition when these are achieved
- Maintaining good self-care
nursing diagnosis for ad
Risk for wandering Risk for injury (risk for injury) Impaired verbal communication Impaired environmental interpretation syndrome Impaired memory Confusion Caregiver role strain Anticipatory grieving
interventions for ad
Person-centered care approach
Health teaching and health promotion
Referral to community supports
Integrative therapy
Pharmacological interventions
- ariept moderate to mild
- namenda moderate to severe
- namzarix moderate to severe
community support
- Transportation services
- Supervision and care when the primary caregiver is out of the home
- Referrals to day care centers (9-5)
- Information on support groups in the community
- Meals on Wheels: provide meals
- Information on respite and residential services (drop off for weekend)
- Telephone numbers for help lines
- Home health services
